Caring for a child on chemotherapy at home — what every parent needs to know

A fever of 38°C (100.4°F) or above in a child receiving chemotherapy is a medical emergency called febrile neutropenia. Because chemotherapy temporarily lowers the white blood cell count that fights infection, what looks like a mild fever can become serious within hours. Do not wait to see if the fever settles on its own. Call your oncology team immediately or go directly to the emergency department — never give fever-reducing medicine first and then wait, as this can mask the temperature and delay life-saving treatment. Your team will have given you a specific temperature threshold to watch for — follow that figure exactly.

The most effective infection-prevention measure at home is frequent, thorough handwashing — by your child, every family member, and any visitors. Keep your child away from anyone who is visibly unwell, including family members with colds or the flu. Avoid crowded places such as shopping malls and public transport during periods when the white cell count is known to be low (your team will tell you when this is expected). Food hygiene matters too: avoid raw or undercooked eggs, meat, fish, and unpasteurised dairy. Fruits and vegetables should be washed well and peeled where possible. Ask your oncology nurse for the specific infection-control guidelines issued by your child's team, as these can vary by treatment protocol.

Loss of appetite and changes in taste are among the most common side effects of chemotherapy in children. Try offering small amounts of food more frequently rather than three large meals. Many children find cold or room-temperature foods more tolerable than hot foods during treatment. Soft, bland foods — rice, bread, bananas, plain yoghurt — are easier on a sensitive stomach. Avoid forcing food at mealtimes, which can create anxiety around eating. If your child is losing a significant amount of weight or has not eaten for more than two days, tell your oncology team. A paediatric dietitian can suggest approaches tailored to your child's specific treatment and preferences, and in some cases supplemental nutrition may be recommended.

Whether your child can attend school depends on how they are feeling and where they are in their treatment cycle. Many children attend school between treatment cycles when they feel reasonably well and their blood counts have recovered. During the period of low white cell counts following a chemotherapy dose, your team may advise keeping your child at home and away from groups of children. Speak with your oncology nurse and the school together: most schools are experienced in supporting children with cancer, and home tutoring or online access can help maintain learning continuity during times when school attendance is not possible. A hospital school teacher, if available at your centre, can also help.

If your child has a central venous catheter or port-a-cath, your nursing team will provide detailed training before you leave hospital. Key principles: keep the dressing clean and dry; check the entry site daily for redness, swelling, warmth, or discharge; do not let your child swim or submerge the line in water unless your team specifically approves this; secure any external line with a dressing or garment to prevent it being pulled. If the dressing comes loose, contact your team for advice rather than attempting to re-dress it yourself without guidance. Signs of a line infection — redness spreading from the site, fever, or a burning sensation during a flush — need immediate assessment.

Yes, fatigue is one of the most common experiences during chemotherapy and is not a sign that something is going wrong. Chemotherapy affects rapidly dividing cells throughout the body, and the body uses considerable energy to recover between doses. Encourage your child to rest when they feel tired without guilt — this is not laziness, it is recovery. Light activity such as short walks or gentle play, on days when energy allows, can help maintain mood and prevent muscle weakening. Fatigue often follows a pattern linked to the treatment cycle: children typically feel more tired in the days immediately after a dose and gradually improve as the cycle progresses. Tell your team if the fatigue is severe, persistent, or accompanied by breathlessness.